The UB-04 Claim Form - PowerPoint PPT Presentation

PART TWO. The UB-04 Claim Form. Chapter 10. Occurrence Codes and Dates. LEARNING OUTCOMES After completing this chapter, you will be able to define the key terms and:

Copyright Complaint Adult Content Flag as Inappropriate

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.

Download Presentation

PowerPoint Slideshow about ' The UB-04 Claim Form' - evelyn

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

An occurrence code is a two-digit numeric or alphanumeric code that defines a significant event that happened in connection with a claim and affects payer processing of the claim. Occurrence codes and dates factor into payer liability decisions, patient coverage, appropriateness of the services rendered, and Medicare Secondary Payer development. They cover a wide range of circumstances and range from 01 to 69 and A0 to LZ.

The same occurrence code can be listed only once on a claim, although as many as eight different codes (and dates) may be used on a single claim. If more than eight codes are necessary, the next two fields (FLs 35-36, Occurrence Span Code and Date) can be modified to report the overflow by using the from date and leaving the through date blank. If these fields are not available, FL 81 (Code-Code) may be used with the appropriate qualifier.

Occurrence span codes are two-digit numeric or alphanumeric codes that identify significant events that happened over a span of time and affect claim processing and payment. Every occurrence span code must have a beginning (from) date and an ending (through) date in MMDDYY format. Occurrence span codes cover a wide range of circumstances and have two ranges: 70 to 99 and M0 to ZZ.

If applicable, completion of these fields is required for Medicare, Tricare, and commercial claims; they may be required by Medicaid; Blue Cross only requires this information when specified under a particular plan or contract

If more than one occurrence code is listed, enter the codes in alphanumeric sequence (numeric codes first, followed by alphanumeric codes) in the following order:

Line 1 (FLs 35a-36a) should be filled in first

Line 2 (FLs 35b-36b) should follow

If more than four codes are necessary, FL 81 (Code-Code) may be used with the appropriate qualifier (A3).